Endocarditis

Endocarditis


Definition:

Endocarditis is an infection of the inner lining of your heart (endocardium).

Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in severe cases, surgery.

Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.

Symptoms:


Endocarditis may develop slowly or suddenly — depending on what's causing the infection and whether you have any underlying heart problems. The infection can infect different people differently, so signs and symptoms vary. They may include:

• Fever
• Chills
• A new or changed heart murmur — abnormal heart sounds made by blood rushing through your heart
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Paleness
• Persistent cough
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood in your urine (either visible or found in a doctor's viewing of your urine under a microscope)
• Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
• Osler's nodes — red, tender spots under the skin of your fingers
• Petechiae (puh-TEE-key-e) — tiny purple or red spots on the skin, whites of your eyes or inside your mouth

When to see a doctor
If you develop signs or symptoms of endocarditis, see your doctor right away — especially if you have risk factors for this serious infection, such as a heart defect or a previous case of endocarditis.
Although less serious conditions can cause similar signs and symptoms, you won't know for sure until you're evaluated.

Causes:

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible.
Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through:

• Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums are in poor condition.
  
• An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
  
• Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.
  
• Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.

Typically, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.
Most people who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply.


Complications:


Endocarditis can cause several major complications:

• Stroke and organ damage. In endocarditis, clumps of bacteria and cell fragments (vegetations) form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs, kidneys or extremities. This may cause various problems, including stroke or damage to other organs or tissues.
  
• Infections in other parts of your body. Endocarditis can cause you to develop pockets of collected pus (abscesses) in other parts of your body, including the brain, kidneys, spleen or liver. An abscess may develop in the heart muscle itself as well, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
  
• Heart failure. Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure — a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it's usually fatal.

Treatments and drugs:


The first line of treatment for endocarditis is antibiotics. Sometimes, if your heart valve is damaged by your infection, surgery is necessary.

Antibiotics
If you have endocarditis, you may need high doses of intravenous (IV) antibiotics in the hospital. Blood tests may help identify the type of microorganism that's infecting your heart. This information will help your doctor choose the best antibiotic or combination of antibiotics to fight the infection.

You will usually need to take antibiotics for four to six weeks or longer to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue IV antibiotic therapy with visits to your doctor's office or at home with home-based care. You'll need to see your doctor regularly to make sure your treatment is working.
Report to your doctor any signs or symptoms that your infection is getting worse, such as:

• Fever
• Chills
• Headaches
• Joint pain
• Shortness of breath

Diarrhea, a rash, itching or joint pain may indicate a reaction to an antibiotic — another reason to call your doctor.
See your doctor immediately if you experience shortness of breath or swelling in your legs, ankles or feet. These signs and symptoms may indicate heart failure.

Surgery
If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that's caused by a fungal infection.
Depending on your condition, your doctor may recommend either repairing your damaged valve or replacing it with an artificial valve made of animal tissue or man-made materials.